Rotationplasty turns an ankle into a knee

Thanks to an innovative surgical procedure, a young bone cancer survivor can still ride a scooter and jump rope, and is looking forward to playing softball

BY Katrina Burton

photo by Wyatt McSpadden

When 10-year-old Elise Robinson felt pain in her right knee three years ago, her pediatrician thought it was growing pains.

But the pain persisted, so Elise and her parents visited an orthopedic surgeon.

Scans revealed a tumor in her right tibia, the larger of the two bones between the knee and the ankle. A biopsy confirmed the tumor was an osteosarcoma – the most common type of bone cancer in children.

Elise and her family made their way to the MD Anderson Children’s Cancer Hospital, where they met orthopedic oncologist Valerae O. Lewis, M.D. Lewis proposed a procedure called rotationplasty to remove Elise’s cancer while preserving her mobility.

To perform the procedure, surgeons remove the upper portion of the leg, the knee and several inches below the knee to ensure all cancer cells are excised.

Then they rotate the remaining portion of the lower leg 180 degrees and attach it to what’s left of the upper leg. The rotated foot is now on the same plane where the knee used to be, with the toes pointing backward and the heel facing frontward.

“In this rotated position, the ankle acts like a new knee joint,” says Lewis, chair of Orthopaedic Oncology.

The foot fits down into a prosthetic leg.

Essentially it turns an above-the-knee amputation into a below-the-knee amputation and affords the patient better control, function and mobility.

“The aim of the surgery is to offer patients the best possible functionality,” Lewis says.

“Most patients eventually will be able to walk unaided and return to the sport of their choice.”

Elise’s mom, Jennifer, at first was hesitant to agree to rotationplasty.

“I was concerned about how people would react if they saw Elise without her prosthesis,” says Jennifer. “I thought about the stares and questions from friends and family, and especially strangers.”

Elise, however, wanted to give it a try. She likes playing sports, and rotationplasty would allow her to remain active.

“Most sports are possible, Lewis says, “especially those where knee motion is important, such as bicycling, skating and soccer.”

Senior physical therapist Alexander Penny played a big part in Elise Robinson’s recovery following rotationplasty surgery.

Elise’s other two options were an amputation or limb salvage – a surgical procedure that replaces a diseased bone with a replacement constructed from a metal implant, a bone graft from another person, or a combination bone graft and metal implant.

Neither of which would allow Elise to remain as active as a rotationplasty because they rule out participation in high-impact sports. In addition, limb salvage would require Elise to undergo several more operations in the future, while any further surgery is rare following rotationplasty.

Elise’s treatment was aggressive. She underwent chemotherapy for 10 weeks before surgery and 20 weeks after surgery, as well as a year of healing before she was able to wear her prosthetic leg.

She now walks unassisted, and with physical therapy soon will be running.

Brimming with confidence, she’s looking forward to taking the field for softball this fall, plays double bass in her school’s orchestra and walks the runway at the annual back-to-school fashion show hosted by MD Anderson Children’s Cancer Hospital and the Galleria.

“Elise is extremely proud of her prosthetic leg and shows it off whenever she has a chance,” boasts her mom.

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